Client Audit Manager

Manager Of Client Audit

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

CVS Health is currently looking for a dynamic individual to join our team in a Manager role. In this client facing project management role, you will be responsible for coordinating, managing and assisting with audits and using broad and deep system set-up and adjudication knowledge. In this position you will work closely with various government auditors, 3rd party consultants and auditors, client account teams, legal and trade areas to ensure the completion of government audits with consistency and minimal disruption to the business. Additionally, you will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process and to improve, develop and deliver on automation projects and complex analyses specifically related to audit deliverables. This position will also be expected to be analytical, able to understand regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and respond to all the auditor questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.

As a Manager of Client Audit, you will be responsible for the following :

• Work directly with the government auditors, the client and all the internal business areas involved in the audit.
• Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities.
• Have a deep knowledge base of Medicaid and Exchange regulations, as well as having some knowledge around Med D.
• Work independently with limited direction from the Sr Manager.
• Coordinate, manage, track the audits from start to closure.
• Review and research all questions from the auditor and client.
• Work through and resolving any alleged issues; working strategically and achieving results.
• Work with the right business leaders to ensure responses are accurate and senior leaders are aware of any issues in accordance with regulatory timelines.
• Respond back to the auditor / client.
• Understand the intricacies of claim adjudication in order to answer questions related to the various claim testing sections, answering their questions correctly and confidently.
• Identify process enhancements, as well as any gaps in controls within the business areas being audited.
• Raise the appropriate items to senior leaders and doing so timely.
• Documenting correspondence with internal partners, clients, and auditors.
• Tracking all audit progress to ensure that all deliverables are provided by due dates.

The ideal candidate will possess the following :

Required Qualifications :

Preferred Qualifications :

Education :

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $54,300.00 - $145,860.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

We anticipate the application window for this opening will close on : 11 / 25 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.